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Dignity Therapy: A Novel Psychotherapeutic Intervention for Patients Near the End of Life

From the Department of Psychiatry, Family Medicine, Community Health Sciences, and Faculty of Nursing, University of Manitoba; Manitoba Palliative Care Research Unit and Patient and Family Support Services, CancerCare Manitoba; St Boniface General Hospital, Winnipeg, Manitoba, Canada; and Edith Cowan University, Perth, Australia

Address reprint requests to Harvey Max Chochinov, MD, PhD, CancerCare Manitoba Room, 3017-675 McDermot Ave, Winnipeg, Manitoba, Canada R3E 0V9; e-mail: harvey.chochinov{at}cancercare.mb.ca

PURPOSE: This study examined a novel intervention, dignity therapy, designed to address psychosocial and existential distress among terminally ill patients. Dignity therapy invites patients to discuss issues that matter most or that they would most want remembered. Sessions are transcribed and edited, with a returned final version that they can bequeath to a friend or family member. The objective of this study was to establish the feasibility of dignity therapy and determine its impact on various measures of psychosocial and existential distress.

PATIENTS AND METHODS: Terminally ill inpatients and those receiving home-based palliative care services in Winnipeg, Canada, and Perth, Australia, were asked to complete pre- and postintervention measures of sense of dignity, depression, suffering, and hopelessness; sense of purpose, sense of meaning, desire for death, will to live, and suicidality; and a postintervention satisfaction survey.

RESULTS: Ninety-one percent of participants reported being satisfied with dignity therapy; 76% reported a heightened sense of dignity; 68% reported an increased sense of purpose; 67% reported a heightened sense of meaning; 47% reported an increased will to live; and 81% reported that it had been or would be of help to their family. Postintervention measures of suffering showed significant improvement (P = .023) and reduced depressive symptoms (P = .05). Finding dignity therapy helpful to their family correlated with life feeling more meaningful (r = 0.480; P = .000) and having a sense of purpose (r = 0.562; P = .000), accompanied by a lessened sense of suffering (r = 0.327; P = .001) and increased will to live (r = 0.387; P = .000).

CONCLUSION: Dignity therapy shows promise as a novel therapeutic intervention for suffering and distress at the end of life.

Supported by the Cancer Council of Western Australia (L.J.K.) and grants from the American Foundation for Suicide Prevention and the National Cancer Institute of Canada, with funding from the Canadian Cancer Society. Dr Chochinov is a Canada Research Chair in palliative care, funded by the Canadian Institutes for Health Research.

This article reports original research; none of the results have been published previously, nor have they appeared in conference proceedings, abstracts, or reports. The outline of questions used for dignity therapy has appeared in Journal of the American Medical Association (Chochinov HM: Dignity-conserving care: A new model for palliative care. JAMA 287:2253-2260, 2002).

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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